corneal_abrasion
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Table of Contents
corneal abrasions
see also:
patient information sheets
introduction
- patients with a possible open globe injury should be examined with extreme caution, and clinicians must avoid placing pressure on the globe (eg, with lid eversion or foreign body [FB] removal) or using eye drops until this injury is ruled out.
red flags to exclude
- possible open globe injury or penetrating injury
- corneal laceration
- mechanism of injury suggestive of penetrating trauma eg. hammering, drilling
- corneal infection
- assess for corneal infiltrate / anterior chamber cells (“AC reaction”)
- increased risk if contaminated object caused the abrasion eg. plants
- retained foreign body - this is likely if there are vertical linear abrasions
- patients at risk of recurrent erosion syndrome (RES)
- sharp objects such as paper, fingernail, tree branch, FB or plant
- other risk factors, corneal dystrophies (eg. epithelial basement membrane dystrophy (EBMD)), diabetes, ocular rosacea, dry eye syndrome
- major recurrent attacks occur with a median of 60 days
- some have daily minor issues on waking - perhaps related to REM sleep
- Mx is mainly long term use of lubricating ointment each night +/- doxycycline/topical steroids
assessment
- evert upper eyelid to exclude FB
- use slit lamp with cobalt blue light and fluorescein stain to document position and size
- consider performing Seidel test to exclude laceration:
- application of flourescein drops near a laceration results in loss of the green pigment streaming away from site of laceration due to dilution from aqueous humor (do not use the strips near lacerations)
- see Youtube demo
- a Wood's lamp - UV light for dermatologic assessment should NOT be used for corneal flouroscein staining eye examinations as:
- 365nm is the wrong spectrum for fluorescein - you need cobalt-blue light (~450–490 nm) viewed through a yellow filter
- 365nm thus gives much lower sensitivity for detecting corneal pathology (only ~50%)1)
- 365nm gives UV-A radiation to the sensitive eye - indeed in normal use of a Wood's lamp, the patient should close their eyes if near the face
- options for cobalt-blue light for flouroscein examinations
- the cobalt-blue setting on a slit lamp
- rotate the knob - don't use the “red free light” which is a lever setting
- Eidolon Bluminator Blue version
- compact hand held LED device with a 7.5x magnifier built-in (28 diopter)
- powered by a non-removable ultrasonically welded silver oxide battery said to last 3-5 yrs
- Eidolon Bluminator Darkfield version
- Blue LED with Yellow Filter Lens for better contrast
- cobalt blue penlights
management
- if suspect infection, laceration or AC reaction, contact ophthalmology
- if FB present, remove it
- if no infection or laceration:
- chloramphenicol ointment or drops qid for 3-5 days
- if severe pain, consider stat dose of cycloplegic (eg. homatropine 2% drops)
- avoid eye pads as they tend to delay healing although if there is a large epithelial defect, a double eye pad may be used for 24hrs to reduce discomfort
- do NOT pad the eye if caused by a plant
- do NOT give LA drops to take home
- dim lights, cool compresses, rest, oral analgesia prn
- if risk of RES then consider paraffin based lubricant ointment (eg. Refresh nighttime, Polyvisc) nocte for 3 months
- consider follow up by ophthalmology (or perhaps GP) if either:
- plant or organic matter caused the abrasion
- symptoms not improving within 48hrs
- unable to evert eyelid to exclude FB - eg. children
- patient information:
- advise the pain will return when the LA wears off and this may feel like they still have a FB
- return if increasing pain or decreased vision
- advise of risk of RES
- if wears contact lens, discard previous lens and resume contact lens wear with a fresh lens once has been asymptomatic for 1 week
corneal_abrasion.1785481506.txt.gz · Last modified: 2026/07/31 07:05 by gary1